Sept. 30 (UPI) -- Idaho has sought approval from the federal government to impose work requirements for enrollees who seek coverage under the Affordable Care Act's expanded Medicaid provisions.
Idaho's application, submitted to the Centers for Medicare and Medicaid Services on Friday, comes in the wake of recent court rulings that have struck down similar proposals elsewhere.
In the past months, more than a dozen states have moved to impose work requirements on citizens who enroll under the Medicaid expansion -- among them, New Hampshire, Arizona, Indiana, Kentucky, Michigan, Ohio, Utah and Wisconsin.
Though most of the states have yet to implement their proposals, those that have sought federal approval have come up short.
Nearly 286,000 Idahoans are covered by Medicaid, according to figures from the state's Department of Health and Welfare. The expansion would add an estimated 90,000 people to the rolls, at a cost of approximately $400 million.
Expansion guidelines allow Medicaid to be available to people who earn up to 138 percent of the federal poverty level -- about $17,000 a year for a single adult, and $35,500 for a family of four.
Under terms of the new Idaho proposal, citizens between the ages of 19 and 59 would have to be employed at least 20 hours per week, or be enrolled in a school or volunteer program for the equivalent number of hours.
The provision would include exemptions for those with physical or mental disabilities, pregnant women, caretakers of children under 6 years old and caretakers of children with disabilities.
Republican John Vander Woude, a legislator who represents the state's 22nd District, was the sponsor of the legislation.
"Medicaid expansion was [designed] for the working poor," Vander Woude said in early September in testimony to support increasing Medicaid requirements. "So I'm just baffled at times that we're fighting so hard on work requirements. ... These people are already working. So I don't know what the issue is."
"I don't think it's overburdensome," he said. "I think we've made enough exemptions in the work requirements."
Despite the exemptions, the Idaho measure faced a rocky path to approval, with a previous version failing in committee in the wake of news surrounding the Kentucky and Arkansas rulings.
"The purpose of the Medicaid expansion is to provide health care access to low-income Idahoans," said Sam Sandmire, of Reclaim Idaho, an advocacy group that spearheaded the state's 2018 Medicaid ballot initiative.
"The vast majority of Idahoans in the gap are working," he said. "This isn't about not working."
Sandmire said his group fears there is "a great risk" that the paperwork restrictions associated with the new proposal will sweep thousands from the state's Medicaid rolls, forcing them to seek "expensive emergency room care."
A recent analysis by the Kaiser Family Foundation estimated that as many as 4 million able-bodied adults could lose coverage nationwide as a result of pending work requirements in several states.
A U.S. district court struck down a New Hampshire proposal in late July, when that state sought to impose 100 hours of "community engagement" requirements on new Medicaid enrollees. Similar provisions in Arkansas and Kentucky also failed to pass judicial muster.
"The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve the working-age, able-bodied adults does not make sense," CMS Administrator Seema Verma said in a 2017 speech before the National Association of Medicaid Directors.
Verma has spoken on record repeatedly as a supporter of work requirements for Medicaid.
"We believe, as have numerous past administrations, that states are the laboratories of democracy and we will vigorously support their innovation, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program," Verma said in March.